When you look in the mirror, do you feel too fat, even if you are slim? Do you feel afraid to eat, even if you are hungry?

If you answer yes to these questions, you may have anorexia nervosa, a serious, life-threatening disorder.

When we hear the phrase “anorexia nervosa,” an image of an emaciated person with barely any appetite comes to mind, but when we take a more detailed look, we discover that the real picture of an anorexia nervosa patient is quite the opposite.

He feels hungry, but is afraid to eat due to psychological reasons, and this is the real root of his problem.

So follow along, my dear; To learn what anorexia nervosa is, its symptoms, treatment, and resulting complications, and also to learn about the treatment of anorexia nervosa in teenage girls.

What is Anorexia Nervosa

Anorexia nervosa, is an eating disorder and severe restriction in the intake of calories and types of food, leading to significant weight loss, or the inability to maintain an appropriate body weight for height, age, and health condition.

This disorder is accompanied by a distorted self-image of the body and an intense fear of gaining weight.

Individuals with anorexia nervosa see themselves as obese or bulky, when in fact they are severely underweight.

The distorted view that affected people have regarding their weight or body shape greatly affects how they evaluate themselves and their personal feelings.

Out of fear of gaining additional weight, they resort to severely restricted diets and engage in intense and moderate exercise.

Anorexia nervosa is a serious disorder that requires treatment, as excessive weight loss can lead to malnutrition and serious health problems that lead to death.

It is more common among females, and usually appears during adolescence, as it is classified as the third most common chronic disease in girls, and statistics indicate that one in every 200 girls may be affected by this disorder.

Anorexia Nervosa Types

Anorexia nervosa can be classified into three types:

Restrictive anorexia nervosa

People with this type tend to restrict food carefully, such as counting calories, and avoiding certain meals.

They may follow strict rules, such as choosing food according to its color, and this type is often accompanied by intense exercise.

Bulimia nervosa

It is characterized by compulsive and disorderly overeating, followed by unhealthy efforts to cope with overeating, and thus abdominal discomfort.

Sufferers use common methods; To reduce calories consumed, including voluntary vomiting, fasting for long hours, using laxatives, using enemas, and exercising excessively.

Atypical anorexia nervosa

In this type, a person can maintain a normal weight, even after significant weight loss due to restriction in food intake.

Individuals face problems with distorted perception of their body shape, and suffer from an intense fear of gaining weight, even though their weight may remain within the normal range.

Each of these types shows how anorexia nervosa can affect dietary and emotional behavior in different ways, all of which need special understanding and treatment.

Anorexia Nervosa Symptoms

Since anorexia nervosa is a complex health disorder, its main sign is excessive weight loss.

As for atypical anorexia nervosa, the person maintains a moderate weight despite massive weight loss, as mentioned previously.

Nutrient deficiencies can lead to other physical signs and symptoms, including:

• Severe loss of muscle mass.
• Lethargy, fatigue, and exhaustion.
• Reduction of Blood pressure.
• Dizziness and nausea.
• Low body temperature with cold hands and feet.
• Abdominal bloating or upset.
• Skin dryness.
• Swelling of hands and feet.
• Hair loss.
• Amenorrhea or less frequent menstrual periods.
• Infertility.
• Insomnia.
• Loss of bone density that increases the risk of fractures.
• Brittle nails.
• Constipation.
• Disorder or irregular heartbeat.
• Increased facial hair.
• Bad breath and tooth decay in people who vomit constantly.

The person may also exhibit certain behaviors, such as:

• Imposing restrictions on the total amount of food eaten.
• Show excessive interest in weight, body size, diet, and calories.
• Exercising too much, taking laxatives, or vomiting.
• Monitor body weight constantly.
• Talking about being fat or overweight.
• Denying feelings of hunger, or avoiding meal times.
• Cooking food for others without eating it.
• Isolation from friends and social interaction.
• Suffering from signs of depression.

The person may associate eating with feelings of guilt, appear unaware of anything wrong, or be unwilling to acknowledge their food-related problems.

Not all people with this condition behave the same way, and some individuals may have atypical anorexia nervosa, which means their weight will not be low.

Anorexia Nervosa Causes

Experts don't know exactly why anorexia nervosa occurs, but genetic, environmental, biological, and other factors may play a role.

For some people, this disorder also develops as a way to control an aspect of their life. Whenever a person exercises control over their eating, they feel successful, and thus this behavior continues.

Anorexia Nervosa risk factors

Many factors may increase a person's risk of developing anorexia nervosa, including:

• The person has previously been criticized regarding his or her eating habits.
• A history of being bullied or ridiculed, especially about weight or body shape.
• Feeling pressure from society or profession to stay thin.
• Low self-esteem.
• Anxiety.
• A personality that tends toward obsessiveness or perfectionism.
• History of dieting.
• Pressure to adapt to cultural norms, which are not compatible with their culture.
• Historical traumas such as racism.

There are also biological and genetic factors that the person may have a higher chance of developing an eating disorder if they:

• He has a relative who suffered from a similar disorder.
• There is a family history of depression or other mental health problems.
• He suffers from type 1 diabetes.

In 2015, researchers found that people with anorexia nervosa may have different compositions of gut microbes compared to people without the condition, and this may contribute to greater anxiety, depression, and weight loss.

Anorexia Nervosa Diagnosis

Anorexia nervosa is diagnosed by a health care provider, based on the diagnostic criteria listed in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

There are three main criteria for diagnosing anorexia nervosa:

1. Restricting calorie consumption, which leads to weight loss or no gain, resulting in a significantly lower body weight, given the patient's age, height, and stage of development.
2. Extreme fear of gaining weight or becoming fat.
3. Having a distorted perception of oneself and one’s health condition, in other words, being unable to realistically assess one’s body weight and shape. She believes that her appearance has a significant impact on her self-worth, and denies the medical risk of her current low body weight and food restriction.

Even if the patient does not show all of the above signs, she may still have a serious eating problem.

The guide uses the body mass index (BMI); To assess the severity of anorexia, there are cases where a person meets the criteria for anorexia nervosa but is not very thin. These cases are called “atypical anorexia nervosa.”

If there are signs and symptoms of anorexia, the doctor will begin with a complete medical history and physical examination, and the psychologist will likely ask questions about the following topics:

• Dietary history of food preferences or dietary restrictions.
• History of exercise.
• Psychological history.
• How often body weight is checked.
• Frequent overeating, vomiting, and bowel habits such as the use of diet pills or laxatives.
• Family history of eating disorders.
• Menstrual status (whether or not menstrual cycles are regular).
• History of medication use or previous treatment.

It is important to remember that a patient with anorexia, or any eating disorder, has a better chance of recovery if diagnosed early.

If you know someone who is experiencing signs and symptoms of anorexia, it's important to talk with a healthcare provider as soon as possible.

Anorexia Nervosa diagnosis tests

Although there are no specific laboratory tests to directly diagnose anorexia nervosa, these tests help rule out any diseases that may be causing weight loss and evaluate the physical damage that weight loss and hunger may cause.

Among the tests used are the following:

• Comprehensive blood test: to evaluate general health status.
• Blood electrolyte test: to check dehydration and the balance of acids and bases in the blood.
• Serum albumin test: to check liver health and nutrient deficiencies.
• Electrocardiogram (EKG): to check the health of the heart.
• Bone density test: to check for osteoporosis.
• Kidney functions.
• Liver functions.
• Thyroid functions.
• Vitamin D levels.

Pregnancy tests are performed for females of childbearing age, and hormone tests are performed in the event of indications of menstrual disorders. To rule out various other causes.

Anorexia Nervosa Complications

Continuing the condition for a long time leads to serious complications that may lead to death, so the diagnosis, convincing the patient, and starting treatment must be as quickly as possible. These complications include:

• Failure in the functions of some important organs in the body such as the heart, kidneys, and brain.
• Severe decrease in blood pressure, pulse, and respiratory rate.
• Arrhythmia.
• The patient may suffer from osteoporosis; As a result of a deficiency of calcium and important minerals.
• Imbalance of salts in the body.

Anorexia Nervosa in Teenagers

Discovering that your teenage daughter has anorexia nervosa may be difficult, but your support is essential in her treatment journey. Here are some guidelines to help you deal with this condition:

1. Communicate openly with your daughter

Start discussing your concerns with her in a frank manner, but without blaming or harshness, and express your support and willingness to listen to her as a friend.

Her first reaction may be denial or defensiveness, so try to remain calm and avoid criticism or scolding; To avoid exacerbating the problem.

2. Book an appointment with the doctor

Your daughter should have a physical examination with her family doctor; To rule out any other health problems, start a psychological evaluation and speak with a nutritionist as soon as possible.

3. Participate in your daughter's treatment

Your daughter mustn't be just a spectator in the treatment process. Encourage her to participate and explain to her the importance of early intervention to overcome this disorder.

Remember that delaying diagnosis and treatment can make the recovery process more difficult.

In this way, you can provide the necessary support to your daughter and help her overcome anorexia nervosa during adolescence.

Anorexia Nervosa Treatment

My dear, the treatment journey can be difficult, but remember that you are not alone, as most women with this disorder face the challenge of accepting the existence of the disease at first, and this is completely normal.

To start, realize that asking for help is a sign of strength, not weakness. Every step towards recovery, no matter how small, is a huge victory. It is very important to diagnose and treat the condition in the early stages; To avoid more serious consequences.

Treatment goals will focus on:

• Stabilize your weight and prevent further decrease, so you will receive the necessary nutritional support; To restore a healthy weight and appropriate energy levels.
• Eliminate vomiting and binge eating behaviors, develop healthy eating habits, and practice a more positive relationship with food.
• Addressing mental problems such as lack of self-confidence and distortions in body image, and learning healthy ways of thinking and managing emotions.
• Build long-term behavioral changes, and you'll be equipped with the necessary skills; To maintain your mental and physical health in the long term.
• Disorders such as depression and anxiety often coexist, so treatment will include a plan to address any other psychological conditions that are present.

Treatment options vary based on your needs:

Psychotherapy

Psychotherapy is your companion in exploring new ways of thinking about food and your self-image. This type of therapy will help you:

• Change your unhealthy thinking patterns about body weight and food, and replace negative thoughts with positive and balanced ones.
• Develop healthy eating habits, learn how to build a better relationship with food, and enjoy eating without worry or fear.
• Dealing with difficult situations in a healthy way, and acquiring effective coping skills; To avoid resorting to behaviors that are harmful to the soul and body, such as vomiting food or avoiding it completely.

There are different types of psychotherapy, each with a special approach:

• Cognitive behavioral therapy (CBT): This is the most common type of treatment for anorexia nervosa. It helps you identify and correct unrealistic thoughts and fears related to food and appearance, and gradually practice new behaviors toward recovery.
• Acceptance and integrative therapy (ACT): This type focuses on accepting your thoughts and feelings without judging them, and helps you direct your energy towards valuable goals in your life that are not related to weight or appearance.
• Group therapy: Provides you with the opportunity to connect with people facing similar experiences, share experiences, and support each other in your recovery journey.
• Family therapy: This type helps your family understand their role in supporting you and restoring your health, and also develops a cooperation plan between you.

Remember, my dear, that choosing the type of psychological treatment that is appropriate for you depends on your personal needs and preferences. Do not hesitate to discuss the different options with your psychiatrist, and share any concerns or questions you have.

Medications 

Your doctor may recommend medications to treat anxiety and depression; To improve mood and enhance the recovery process.

In addition, he may suggest Zyprexa (olanzapine); To help restore a healthy weight.

The doctor may also prescribe medications to regulate the menstrual cycle, if it is affected by loss of appetite, to restore hormonal balance.

Nutritional consultations

The dietitian will guide you towards a healthy, balanced diet that meets your needs and ensures a healthy return to your weight.

Hospital treatment

In some severe cases of anorexia nervosa, hospitalization may become a haven for you to protect your health and recovery. Hospitalization may be necessary if:

• Severe weight loss: If your weight reaches a level that threatens your health and causes malnutrition, you may need intensive medical care in the hospital; To ensure compensation for the deficiency and stability of your physical condition.
• Serious health problems: If anorexia nervosa causes severe health complications, such as heart disorders, severe depression, or thoughts and attempts of suicide.

In light of the above, my dear, anorexia nervosa is considered a health and social problem that requires attention and care. This disorder does not only result from genetic and environmental factors but is also affected by psychological pressures and cultural and media influences.

It causes great suffering to those affected, their families, and their community, as well as the risk of possible death, so we must all be aware and responsible towards this issue, and search for effective and sustainable solutions.

Frequently Asked Questions about Anorexia Nervosa

Does the patient recover from anorexia nervosa?

Individuals with anorexia nervosa can achieve restoration of most or all of their lost body weight, and the physical and hormonal problems caused by this disorder improve dramatically, but recovery depends on effective psychological support and ongoing medical intervention.

When is anorexia dangerous?

Anorexia is considered a serious matter when it results in a severe lack of food intake, which leads to a negative impact on weight and healthy nutrition. When this condition continues for a long time, it causes a deficiency of essential nutrients, leads to general weakness, and may affect the functions of vital organs.

Written by: Dr. Nahed Abd Alhakam Ahmad

Translated by: Ph. Marah Mohamad

Sources:

healthdirect

clevelandclinic

evolvetreatment